Abstract
The ability to form biofilms is a recognized trait of Stenotrophomonas maltophilia, but the extent of its clinical relevance is still unclear. The present multicenter prospective study (ANSELM) aims at investigating the association between biofilm formation and clinical outcomes of S. maltophilia infections. One hundred and nine isolates were collected from various geographical origins and stratified according to their clinical relevance. Biofilm formation was evaluated by the microtiter plate assay and correlated with microbiological and clinical data from the associated strains. Antibiotic susceptibility of the planktonic cells was tested by the disk diffusion technique, while antibiotic activity against mature biofilms was spectrophotometrically assessed. Most strains (91.7%) were able to form biofilm, although bloodborne strains produced biofilm amounts significantly higher than strains causing hospital- rather than community-acquired infections, and those recognized as “definite” pathogens. Biofilm formation efficiency was positively correlated with mechanical ventilation (p = 0.032), whereas a negative relationship was found with antibiotic resistance (r2 = 0.107; p < 0.001), specifically in the case of the pathogenic strains. Mature S. maltophilia biofilms were markedly more resistant (up to 128 times) to cotrimoxazole and levofloxacin compared with their planktonic counterparts, especially in the case of bloodborne strains. Our findings indicate that biofilm formation by S. maltophilia is obviously a contributing factor in the pathogenesis of infections, especially in deep ones, thus warranting additional studies with larger cohort of patients and isolates.
Highlights
Stenotrophomonas maltophilia is a globally emerging multidrug-resistant Gram-negative pathogen
We evaluated the existence of a relationship between biofilm formation efficiency and antibiotic resistance, and the results are summarized in Figures 7 and 8
To the best of our knowledge, this is the first prospective, multicenter study investigating the association between the biofilm formation capability of S. maltophilia strains and the clinical outcomes of infections they cause, by using a representative collection of isolates stratified according to their clinical relevance
Summary
Stenotrophomonas maltophilia is a globally emerging multidrug-resistant Gram-negative pathogen. The findings revealed that biofilm formation is highly conserved in S. maltophilia and occurs with relevant efficacy leading to high biomass amount [2,5,13,14,15,16,17,18,19,20,21]. Maltophilia and occurs with relevant efficacy leading to high biomass amount [2,5,13,14,15,16,17,18,19,20,21] These studies were aimed at investigating the phenotypic and genotypic characteristics or virulence traits, without providing evidence for the relationship between biofilm formation and the clinical course of diseases
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